title: Occipital nerve stimulation for intractable chronic cluster headache or migraine: a critical analysis of direct treatment costs and complications.
abstract: BACKGROUND
  Occipital nerve stimulation (ONS) has been shown to be effective for selected patients with intractable headache disorders. We performed a prospective critical evaluation of complications and direct treatment costs.
  
  
  METHODS
  Twenty-seven patients with chronic cluster headache (CCH, N  = 24) or chronic migraine (CM, N = 3) underwent a trial phase with bilateral ONS and subsequent implantation of a permanent generator (IPG), if responsive to treatment according to predefined criteria. Procedural and long-term complications as well as direct treatment costs of neuromodulation therapy of ONS were recorded over a mean follow-up period of 20 months (range 5-47 months).
  
  
  RESULTS
  Twenty-five of 27 patients (93%) responded to treatment. Twenty-one complications in 14 patients were identified, necessitating reoperation in 13 cases. Overall treatment costs were €761,043, including hardware-related costs of €506,019, costs for primary hospital care of €210,496, and complications related to hospitalization costs of €44,528. This results in a per case-based cost of €9445 for hospitalization and €18,741 for hardware costs, totaling €28,186.
  
  
  CONCLUSIONS
  ONS for treatment of refractory CCH and CM is a cost-intensive treatment option with a significant complication rate. Nevertheless, patients with refractory primary headache disorders may experience substantial relief of pain attacks, and headache days, respectively.
authors.affiliation: Department of Neurosurgery, University Hospital Essen, Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Mueller
authors.forename: Hans-Christoph
authors.initials: HC
authors.lastname: Diener
authors.forename: Philipp
authors.initials: P
authors.lastname: Dammann
authors.forename: Kasja
authors.initials: K
authors.lastname: Rabe
authors.forename: Vincent
authors.initials: V
authors.lastname: Hagel
authors.forename: Ulrich
authors.initials: U
authors.lastname: Sure
authors.forename: Charly
authors.initials: C
authors.lastname: Gaul
mesh_terms: D000328:Adult; D003027:Cluster Headache / Q000191:economics / Q000628:therapy*; D004599:Electric Stimulation Therapy / Q000009:adverse effects* / Q000191:economics* / Q000379:methods; D004567:Electrodes, Implanted / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000191:economics / Q000628:therapy*; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology
keywords: Chronic cluster headache; chronic migraine; complications; occipital nerve stimulation (ONS); outcome; treatment costs